Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Flood Inundation Mapping using Multi-temporal Datasets

Floods are considered the most frequent natural catastrophic events, which effect the human lives and infrastructure. Flooding causes tremendous loss of life and property every year. We used satellite imagery to map flood inundation in Jehlum river for the both pre and post flood scenarios and classified it into major landuse including vegetation, water body, buildup land and the bare soil. The results show that about 40% area was agricultural land, 29% was bare soil, 16% was build up land and 12% area was noted as water body.The categorization of the post flood areas, showed that flood has destroyed the buildup and agriculture lands.The superimposition proposed that agricultural land was 43% before the flood which reduced up to 31%,the normal flow of water was 12% before flood which was increased up to 33%, build up area and bare soil was also decreased up to 10% and 25% respectively. Remote sensing and GIS proved efficient in convergence of optimistic results. Full Tex

SRTM DEM based Neotectonics from Non-Linear Analysis: A Paradigm through Fractal Analysis

Neotectonics amend the river base and causes landscape erosion. This study explores the DEM based differentiation of neotectonics in the northern regions of Pakistan. This method involves vertical and non-linear dissection base on digital evaluation method. This study uses Gliding Box Technique (GBM and GBT) and Box Counting method to evaluate Lacunarity (LA), Succolarity (SA) or 3-Fractals, and Fractal Dimensions (FD). 3-fractals are an attribute used for the recognition of spatial patterns, specifically to compute and differentiate natural textures including natural patterns. This study also investigates vertical dissection using DEM SRTM having spatial resolution of 90m. DEM SRTM measures surface area, plane area as well as the surface ratio. The vertical areas are investigated to make dissection maps and to identify the affects of neotectonics on the roughness of surface. Low value of surface roughness indicates flattened drainage basins and inclination of slope. The Raikot Fault shows higher values of surface roughness towards NE- SW. The surface roughness is mapped to recognize relative uplifts, uneven regions, depressions and pits. Analysis through non-linear method identifies the regions affected by neotectonics activity. Tectonics activity causes deformation and instability in drainage networks. Full Tex

River Profile Modeling Through Surface Deformation Using RS/GIS, A Case Study Swat River

The objective of this appraisal is to determine the feasibility of dam sites in Swat Valley and its peripheries (Northern Pakistan). We exploited SRTM DEM with a spatial resolution of 90m to extract various geomorphic indexes for the dam site feasibility. This research aims at pinpointing areas which can be opted for small dam constructions to overcome the electricity crisis in Pakistan to some extent to meet the national electricity needs. We exercised River profile analysis (RPA), D8 flow popular algorithm, Concavity, Steepness, and Hack-gradient methods to prepare interpolated maps for the Steepness index, Concavity index, Relative uplift rates, and other parameters like value zoom, vector zoom, surface zoom, density zoom, relief zoom and contour map. The drainage pattern of this area indicates that there are high relative uplift rates, erosion, steepness and concavity in NE, NW and SW. The DEM based RPA develops as much easier and faster approach to demarcate sites influenced by neotectonics. Full Tex

Flood Inundation Mapping using Multi-temporal Datasets

Floods are considered the most frequent natural catastrophic events, which effect the human lives and infrastructure. Flooding causes tremendous loss of life and property every year. We used satellite imagery to map flood inundation in Jehlum river for the both pre and post flood scenarios and classified it into major landuse including vegetation, water body, buildup land and the bare soil. The results show that about 40% area was agricultural land, 29% was bare soil, 16% was build up land and 12% area was noted as water body.The categorization of the post flood areas, showed that flood has destroyed the buildup and agriculture lands.The superimposition proposed that agricultural land was 43% before the flood which reduced up to 31%,the normal flow of water was 12% before flood which was increased up to 33%, build up area and bare soil was also decreased up to 10% and 25% respectively. Remote sensing and GIS proved efficient in convergence of optimistic results. Full Tex

Novel Technique to Investigate Glacio-fluvial Hypsometry in Hunza Using Local Indicator of Spatial Autocorrelation (LISA)

Hypsometric Integral (HI) displays the effect of active tectonics and sensitivity on geomorphic structures. In this study we calculated HI values for Hunza valley to investigate neotectonics, development of topographic structures and process of erosion using SRTM DEM 90m. ArcGIS and MATLAB is used to generate HI and hypsometric curve (HC). We generated HI and HC values by using D8 algorithm in MATLAB to extract drainage basins for 5 and 6 Strahler orders. HI and HC values show the stages of erosion for instance high values of HI and convex HC displays young and tectonically active stage. We used different grid sizes in ArcGIS to calculate maximum, mean and minimum elevation utilizing different statistical techniques. We used Local Indicator of Spatial Autocorrelation (LISA) instead of Global Moran Index to determine the extent of distribution of clustered, dispersed and randomized HI values. This technique indicates high positive z score for auto correlated data. Regions with high HI value indicate relative uplift, undissected and young structures while low HI values indicate sediment accumulation and shallow earthquakes. Full Tex

Generation of Digital Surface Model (DSM) USING UAV/ QUADCOPTER

Satellite imageries are being used as primary source of information due to their vast coverage and high temporal resolution. Unnamed Aerial Vehicle (UAV) is being used these days because of its accuracy, autonomous flights, cost effectiveness and rapid overview of data. UAV provides a fully or partially autonomous image acquiring platform which is devoid of any manned flight controller. In this research Phantom 3 advanced Quadcopter was used for an image acquisition plan for generation of Digital Surface Model (DSM). Two designs were drawn through this workflow for the reconstruction of Department of Space Science and technology in university of Punjab. For the first design 3D quadcopter is hovered at the height of 120 feet (37 meters) which covered an area of 83 x 130 meter, frontal and sidewise overlapping is 80%, and the camera is kept at an angle of 70° for the double grid type pattern. For second mission design a circular flight is taken to obtain images at the height of 27meters with coverage area of (107 x 106) meter, 45° camera angle and 10° circular angle. For reconstruction of urban area, quadcopter is hovered at relatively greater height of 210 feet (64 meters), following the double grid pattern. In order to attain desired GST, the camera is flown at a constant height over the Area of Interest (AOI). The highly overlapped images obtained using Phantom 3, advanced Quadcopter are then processed using Pix4d software for processing of images. Initially, the common points of adjacent images are matched automatically. After matching similar points, additional geographic information of coordinates and z-value of elevation associated with it is generated in 3D space by sparse point cloud. Then a detailed 3D model along the precise geo location is obtained using dense point cloud. A study surface area and its texture are generated using 3D mesh. Finally, a desired 3D surface model is accurately generated containing desired AOI. The results are analyzed using UAV imagery to generate high resolution DSM. DSM for construction of urban area of Department of Space Science was generated at a very high resolution of 3.55cm and 1.8cm respectively. The accuracy of geo locations can be improved by using GPS loggers or by taking the GCPs. It is suggested by many authors that 3D surface model of reconstruction of building is quite accurate geographically and geometrically, after the comparison of bundle block adjustments, Ground Sampling Distance (GSD) value, 3D matching and average point cloud density of DSM. Thus, the 3D surface models are used in parameters, features extraction and estimation of values including depth and elevation values, in texturing, 3D data collection for 3D visualizations, 3D roof tops and building facades and contour maps and orthodox photos.  Full Tex

Appraisal of Trans Indus, Marwat-Khisor and Bhittani Ranges Thrusting through Geo-spatial Techniques

Himalayan mountain belt was created by the Indo–Eurasian collision. The length of this seismically active mountain belt is almost 2500 km. Southern partition of this zone is marked by the main frontal thrust. We computed the isobase, relative relief, incision, vertical dissection and drainage density maps of the study site. Drainage density is inversely proportional to the rest of computed parameters. Drainage density is less where the incision/deep cutting is high. Pezu and north western parts of the study site are observed vulnerable to tectonic activity and high risks. These sites are the adjoining parts of active faults. The rates of morphological changes and the combination of stripping processes are determined through Surface dynamics maps (SDM). Although it is a handy tool used to evaluate erosion conditions of sags or sub basins. Remote sensing and GIS techniques proved efficient for appraisal of thrust in Marwat Kishore and Bhittani ranges. Full Tex

A Study of Active Chaman Fault System (CFS) using SRTM DEM

Chaman fault is a seismically active fault running over 850km in western region of Pakistan and Afghanistan. It is a major geological structure between Indian and Eurasian plates. Chaman fault is a strike slip fault which is slipping nearly at the rate of 10mm per year. This research includes the evaluation of lithological processes and neotectonics activity using Hypsometric Integral (HI). We calculated values of hypsometric integral using SRTM DEM with 90m spatial resolution in active region of Chaman Fault (CF) and in its locality. We analyzed different mean, minimum and maximum elevations using regular square grids and measured the degree of spatial distribution of HI using Local Indices (LI) of Spatial Autocorrelation (LISA). LISA provides auto correlation for the cluster analysis of hotspots and cold spots of HI values to discriminate uplifted and eroded regions. Full Tex